Spiriva May Improve Asthma Control In Adults
Tiotropium Bromide (Spiriva) is a nice medicine. But, while it’s in the first-line of treatment options for COPD, it’s relegated to a second-line treatment option for asthma. However, a new study shows that Spiriva may benefit some adult asthmatics.
The study followed adults aged 18-75 with moderate, symptomatic asthma for 24 weeks. All the subjects were given in inhaled corticosteroid (ICS). The ICS used for this study was Budesonide (Pulmicort). The subjects were also given Spiriva once daily, salmeterol (Serevent) twice daily, or a placebo Spiriva once daily.
In all the groups, lung function improved. But, lung function improved the most in those taking both an ICS and Spiriva. So, this study shows that Spiriva may be another good option for adult asthmatics in their quest to obtain good asthma control.1
What is Spiriva?
Acetylcholine is a neurotransmitter. It binds with muscarinic receptors on cells lining airways. Once this happens, it causes airway smooth muscles to constrict. It also tells the mucus glands to secrete mucus. The combination of these two effects causes airways to become narrowed. It causes bronchospasm and asthma attacks.
Spiriva is muscarinic. It’s also referred to as an anticholinergic medicine. It has a strong affinity for muscarinic receptors. It binds with them. Once this happens, it prevents acetylcholine from binding to these receptors. The end result is that Spiriva prevents acetylcholine from doing its job. The end result here is bronchodilation.
A similar medicine is ipratropium bromide (Atrovent). It’s essentially the same thing as Spiriva. The main difference between Atrovent and Spiriva is that Atrovent is only lasting four hours. So, it needs to be taken four times every day.
Spiriva, on the other hand, is a long-lasting muscarinic. It stays in your system for 24 hours. This means that it only needs to be taken once daily. So, this is pretty convenient.
Why is Spiriva a second-line asthma option?
Muscarinics used to be used as a front-line treatment for asthma. But, they were relegated to second-line status quite some time ago. This was mainly because bronchodilators and inhaled corticosteroids have proven more useful for ending and for preventing asthma episodes. Usually, that’s all that’s needed.
But, there remain a select group of asthmatics who continue to have difficult to control asthma. This is despite using first-line asthma medicines. When this happens, it’s usually referred to as severe asthma. A diagnosis of severe asthma may signal that it’s time to start considering second-line options, such as Spiriva.2-3)
There have been some studies, such as the one mentioned above, showing that Spiriva may improve lung function. This is because acetylcholine may cause bronchospasm. But, it may also play a role in airway inflammation and airway remodeling. So, a trial of medicines like Spiriva may help to reverse some of this, thereby improving asthma control.2
What to make of this? At the present time, Spiriva is the only muscarinic referred to in the 2018 Global Initiative For Asthma (GINA) Asthma Guidelines. It was added in 2015 as an adjunct medicine to be trialed by those who continue to have poorly controlled asthma despite using first-line medicines.3-4
So, if you continue to have trouble with your asthma, Spiriva may be a good option worth discussing with your physician.
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